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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG COMMENTS O*nd-Buildcr Del@liq
<br />I h@by ,ffim und.r p.ialiy ofp.rjury that I m .xdpl aom th. C.nreloE' Lienk Law fs tnc followins l6on (scc.703 L 5 Busin.$
<br />dd Pofeion Cod4 Any Cny d CNnty which Equir6 r p.mn lo cMstrucl, shd, imFov., dddtf or rcpat y sEulur., Fio (o it!
<br />i$!mc., dso r.qnt6 th. lppli@r fd such p€6it ro 61. a sign.d sLrdol that hc I shc i3 li@n.cd pu^@l lo {r Fovisim of rh.
<br />Cqractor's Licdcd kw (Ch.Dl6 9, Conhacins vidi S6tion 7000 of Divirion 3 oa $c B6ind Md Prof6iotu Co&) oi thlt h€ tr
<br />sirc is .xmF thd.ilom sd lh. b6G ftr rh. all.B.d a.nptim Any viola,tion of S.clion ?Ol I 5 by dy applicdl for 3 p.mn iubjec $.
<br />6ppli@1 to a civil pch.lty of nol moc tha fiv. hu.&.d dolla {1500)
<br />L s ov.d 6r lh. p.op.ny, d n, mpl.ye! wirh w4* a 1hcn solc comp.n.arion, *ill do rh. w.rl d th. shct4 i3 not inladcd
<br />or ofi.rcd ftr s.l. ( S.c 70aa, Bsin6 6d Profcsions Cod. Th. Co.retor'3 Li6s. kw do6 not .!ply ro & oprr ol . prop.dy
<br />who builds or improvB ihmn, ed vho do.s such work hims.lf or h6clf d ,,roush his or hcr @n cmdoy6t providcd that such
<br />inprovdcrls dc not inrod.d or ofir.d for srl. I( howcvr.lh. brildi,gor imp.ovmcni is sold within oc y6 of compld,on, $c
<br />OwDd-Buildcr will havc rh. buda of provins thal hc d sh. not build or inp'ov. lor th. purrosc of 3dc)
<br />_1.6 o*nd oath. popcrir, mqclusit.l, conb&ting *iih licdsdco r&rou to cmhd th.Foldt(sa ,044. Bsin6s ud
<br />ProfBsion Cod.: Thc Co.lr.crd's Li.cns. t w doB nor.ppl, to e omd oaprop&ty who builds or improv6 fia.on. ed who
<br />conrels for slch prcj.ck vnh a contBclo(, li&n$d punudr 10 lhc cmrocrors Liccnsc Lav.)
<br />_l d .,cmpl undd S.crion
<br />-B
<br />& P C fd lhis r.6on
<br />WORKERS COMPENSAT'ION DECLARAIION
<br />I hd.by amm u crp.na,ty ofprjuryooc ollhc lollowintd.cleatiotu,
<br />I n.v. dd will mai.iai. rC..lifisE of Cmlalto S.lfinloE forwo*6'.mp. dis,d Forid.d for by S.cdo.l70o of$c
<br />Labo, Codc, for lnc pafcr@e ol lhc vdt for *hich lllc Fmir ii i$u.d
<br />_t hrvc ddwill tuinr.in wdk6 @mpaBa o. ituu6@, a rcquiad by S.clioo 37m of rr. t$o. Cod.. lo, $. p6fomec. of d.
<br />work try ehich inis pdnir is ilsucd My wdt6' dFrsanon iBumc. 6id od policy ounbd dc
<br />Policy Nuhbcr Erpn s
<br />{Tnis s.crion ncd not b. cwplclcd if $c p.mit ii for O!. hun.lr.d dollas {l l0O} or lc$)
<br />_l cdiS thl ii th. p.rfomee of fic vork ftr which this !.mn t issu.d, I shall nd .nploy oy p.so in ey ntrna so a to
<br />b.clm iubjd lo $c wot6 @op.Eadon laE of c.lifmi,, ud asE. th iflshouldbeon. bj.cr ro rh. wdlc6'
<br />comp.nsarim povisi@ of S.di6 3700 of lh. tilor Cod., I sh.ll, lonhwnh cmply witn fi@ provisions
<br />4-.2/o /
<br />WARIIING: Failu.c ro 3@!r. wdk6 @mpd&rid @voagc i! unhsful. ed sh.ll sobj.d & mploycr lo qimanai paEltica ed civil
<br />fin6 up ro @. hua&cd 0DBed dolld (ll00,000).ii sddjdoi lo th. c6l of @mpcnsarioo. d.mas6 6 proi&d fo thc sccrid 30?6 or
<br />rh. tnbor Cod., int Bt md anm.yt f6
<br />IICIISED.CONIXAEIOBIDECLABAIION
<br />I h@hy amm und.r paalry ofp.rl ury th{ I m licmscd uhdq provisio of Chrpls 9 Gmmoci.S with S.ction 7000) ol Divkion 3 of
<br />thc B6in6r dd Prcf6io.r codc, &d nr licd& ,i ii ruu fo@ dd.fa.cr
<br />EONIIBIJCIIOXIIIDECIGENCT
<br />I hdb, .mm uda Fnalt, ot pajury dar Oft n 3 cofulru.rion ladi.g .gc.cy lor lhc p.rfmdc. of thi vdk fs whicb tis pmn is
<br />h$cd (se 1097, civ. c.).
<br />AIIIICAII]iDEEIABAIION
<br />Ddolido. PmiE-Asb6r6 Nodfi@iio. F.dc.al R.Sulatids (Tidc 40, Pan 6)
<br />_ RcquiEd Lcnd ofNotfic.rion
<br />I c.nify lhar lh. f.d6al r.sulariotu r.gddins sbsros rcmoval e nol applicablc lo this prcj6!
<br />_ I canfy thar I hav. r.ad thi! .pplicdion dd iljl. dd fi. abot. infm.tion is ..r.ct I agE. (o comply *i!n lll City ad Cou.ry
<br />ordin&c6 &d Srarc kws rchring lo building mcrrucrion, sd hdby aulhoriz Epr.gtrdv6 of rhis Cny dd Counry lo otq upoi thc
<br />abovc motioncd prop.ny for in3p..lion purDos6
<br />,?-zzt /a d
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Bu ilding
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />fuleter Release
<br />EXPIREI )
<br />Rough
<br />Service Meter FEI] U I
<br />FINAL a R-4?
<br />'q/^t
<br />B i6 6n7
<br />Notes, Remarks, Etc.
<br />Communications Cable
<br />t-,k'r Adtr*' _
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